Melbourne School of Psychological Sciences - Theses
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ItemSignposts for building better behaviour: a study within a Mexican population of children with acquired brain injury( 2019)Background Children with acquired brain injuries (ABI) often present with poor self-regulation and disruptive behaviour. Children with poor self-regulation are more likely to present with novel mental health problems. Poor self-regulation is a core aspect of disruptive behaviour. Disruptive behaviour risks child safety and undermines their participation in the community. Deficits in self-regulation and disruptive behaviour are exacerbated by the presence of dysfunctional parenting practices as well as high levels of parental trait anxiety, parental stress and social risk. The dysregulation profile has been used to identify children who are at risk of mental health problems in non-clinical paediatric populations. A cognitive behaviour therapy intervention parenting programme (Signposts) seems to be effective in decreasing child disruptive behaviour, dysfunctional parenting practices and parental stress following ABI. The current study aimed to investigate the contribution of parents’ characteristics to self-regulation and disruptive behaviour in children and to then assess the effectiveness of Signposts in reducing children’s disruptive behaviour along with dysfunctional parenting practices following ABI. Methods The study was conducted in Mexico where parents of 77 children with ABI participated in the study. Children and their parents were assessed. The children’s teachers also completed questionnaires regarding the child’s disruptive behaviour. These assessments were conducted prior to the intervention, immediately following the intervention and three months post- intervention. Results and Conclusion This study identified high levels of parent trait anxiety and child disinhibition as major contributors to children’s disruptive behaviour following ABI. Within a Mexican population, distal environmental factors (i.e. parents’ levels of education, their occupations) did not seem to be related with child impairment, whereas proximal environmental factors (i.e. parenting practices, parental stress) appeared to be related to child outcomes. The dysregulation profile may be used as a proxy for risk of novel mental health issues in children with ABI. Signposts was not effective in reducing parental stress or child disruptive behaviour at school, nor was it successful in improving child self-regulation. Signposts was feasible and effective in reducing child disruptive behaviour in the home setting and dysfunctional parenting practices following ABI. These results were maintained at three months post-intervention. The reduction in disruptive behaviour was associated with the implementation of authoritative parenting practices (external regulation).
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ItemEmotional intelligence in acquired brain injury( 2018)Socio-emotional difficulties are among the most clinically striking and psychosocially disabling consequences of moderate to severe acquired brain injury (ABI). However, formal assessment and characterisation of these difficulties has proven challenging. Although emotion processing is theoretically understood to represent a complex and multifaceted set of skills that contribute to adaptive interpersonal functioning, including the ability to experience, identify, use, understand and regulate emotions, existing assessment approaches in ABI tend to be idiosyncratic. Furthermore, many available emotion processing tools lack adequate psychometric properties. A multi-dimensional, theoretically-driven approach would help to elucidate the nature of emotion processing deficits after ABI in a systematic way. Such an approach may offer a means of predicting vulnerability to psychosocial dysfunction after ABI by identifying domains of emotion processing that are most pertinent for functional outcomes. This may prove particularly useful for understanding why a subset of patients experience marked psychosocial dysfunction in the community despite intact performances on traditional neuropsychological tests. The aim of this thesis was to investigate the utility of a multi-dimensional model of emotional intelligence (EI) for conceptualising and assessing emotion processing difficulties after moderate to severe ABI. This aim was investigated over a series of three studies employing a cross-sectional sample of 82 community-dwelling adults with moderate to severe ABI. Participants completed a standardised, normed ability-based test of EI, the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT V2.0), and measures of cognitive, psychological, and community functioning. Study 1 provided initial evidence of the sensitivity of the MSCEIT V2.0 to emotion processing impairments in this sample. This study demonstrated evidence of reliability and validity of the test within this population, with support for a three- rather than four-factor model of EI due to the statistical redundancy of the Using Emotions subscale. In Study 2, two specific EI domains were found to be relevant for community participation outcomes after ABI: the ability to understand emotions was predictive of return to work, and the ability to manage emotions was predictive of community integration. In Study 3, EI assessment was used to identify distinct emotion processing profiles in ABI, including a group that appear particularly vulnerable to poor psychosocial functioning despite broadly intact performance on traditional neuropsychological tests. In combination, these findings provide initial support for the utility of a tripartite model of EI for conceptualising emotion processing deficits after moderate to severe ABI. In addition to offering a means of reconciling the existing literature, this framework may prove useful for guiding approaches to clinical assessment and intervention in ABI. Findings from the series of studies presented here suggest that assessment of EI can help to predict participation outcomes and identify vulnerability to psychosocial dysfunction among patients who appear otherwise largely cognitively intact. In particular, strategic EI skills appear to represent an important target for clinical assessment and intervention given their relevance to psychosocial functioning. The findings of this thesis add to a growing body of evidence supporting the inclusion of socio-emotional skills tests in routine clinical assessment for individuals with brain injury.
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ItemCerebello-cortical and fronto-parietal contributions to working memory function in children born extremely preterm: a diffusion MRI study( 2016)Survivors of extremely preterm birth (<28 weeks’ gestation) and/or extremely low birth weight (<1000 grams) have elevated rates of working memory impairment compared with term-born peers. This impairment may be a core deficit underlying problems experienced by these children in other areas of cognitive, behavioural and academic functioning. Extremely preterm survivors are also at risk of white matter injury and cerebellar injury as a result of neurological disruptions associated with preterm birth. However, it is not yet known whether this injury and developmental disruption to cerebellar white matter connections underlies the working memory deficits seen in this population. It is also unclear whether working memory deficits may be ameliorated through intensive working memory training, and whether white matter microstructural plasticity underlies training gains in working memory capacity. This thesis aimed to examine whether variability in the maturity and microstructural organisation of white matter pathways associated with working memory were related to working memory ability in a group of 7-year-old extremely preterm children. It also aimed to evaluate whether working memory capacity and white matter microstructure were capable of change (functional and neuroplastic change, respectively), in response to the most widely evaluated adaptive working memory training intervention, Cogmed. Sixty participants were recruited from a large cohort of 7-year-old extremely preterm children born in Victoria, Australia. Two white matter pathways in the brain were investigated using probabilistic tractography with diffusion-weighted MRI; the superior longitudinal fasciculus (SLF), a monosynaptic fronto-parietal white matter tract well-recognised for its involvement in working memory function, and the cerebello-thalamo-prefrontal (CTP) pathway, a polysynaptic efferent cerebellar white matter pathway hypothesised to be involved in working memory function. The CTP pathway was further divided into two monosynaptic components; the cerebello-thalamic tract (CT), and the thalamo-prefrontal tract (TP). The diffusion-weighted MRI measures of fractional anisotropy, axial diffusivity, radial diffusivity, and mean diffusivity were used to assess white matter microstructure. The Cogmed working memory training intervention (5-7 weeks) was administered using a double-blinded, placebo-controlled, randomised control trial. In the adaptive Cogmed intervention, activities became more complex with increasing proficiency of the participant, thereby challenging working memory capacity. In the placebo Cogmed intervention, activities remained at a fixed, low level of difficulty. Working memory capacity and white matter microstructure were assessed at baseline and two-weeks post-intervention using gold-standard measures. The study found that, prior to the intervention, immaturity of microstructural connectivity in cerebello-thalamo-prefrontal and fronto-parietal white matter pathways was related to lower working memory performance. Following the intervention, no significant difference in working memory performance or microstructural white matter maturity was noted in children who undertook adaptive versus placebo training. The novel finding of this thesis is that early disruption to the microstructural development of cerebello-cortical white matter pathways (as a result of extremely preterm birth) may represent a potential neurobiological mechanism underlying working memory dysfunction in this population. Evaluation of these tracts in the perinatal period therefore has the potential to identify children at risk of developing working memory deficits later in life, so that close surveillance or early interventions may be applied. However, Cogmed adaptive (versus placebo) working memory training does not appear to be an effective intervention in improving working memory capacity for school-age extremely preterm children.
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ItemA family-centred intervention to reduce challenging behaviours in children with acquired brain injury (ABI)( 2010)Of significant concern for parents following childhood acquired brain injury (ABI) is the often reported sequelae of challenging behaviours. Of equal concern are the often reported bi-directional influences between family-parental burden and stress and long-term behaviour problems. Less is known, however, about the nature and influence of parenting factors such as disciplinary practices and its relationship with children’s behaviour following ABI. Additionally, with recent research indicating that better child outcomes are commonly associated with greater family unity and cohesion, lower levels of parental stress, and increased social support, a family-centred approach to behavioural intervention may prove most effective. Thus, the two main aims of this thesis were to: (1) examine parental disciplinary use and its association with child behaviour following ABI; and (2) investigate the clinical utility and efficacy for a family-centred behavioural intervention programme delivered directly to the parents of children with ABI, in either telephone or face-to-face formats. The results of Study 1 revealed that overreactive and lax disciplinary strategies were endorsed most by parents following childhood ABI. Clinically dysfunctional levels of disciplinary use were associated with children who displayed more challenging behaviour, parents with elevated levels of stress, anxiety and depression, and families experiencing significant dysfunction and social adversity. Study 2 demonstrated that following the delivery of the Signposts for Building Better Behaviour programme, parents reported feeling less stressed and more confident in managing the challenging behaviours of their child following ABI. All parents approved of the strategies taught and a majority felt the materials were helpful in teaching new skills. In its two service delivery modes, the programme was able to reduce the number of challenging behaviours in brain injured children as well as lower dysfunctional parenting practices, stress and family burden. Study 3 revealed that parents continued to report subclinical child behaviour problems and reduced levels of family burden at 6 and 18 months follow-up indicating the long-term treatment effects of the Signposts programme. Further, parents also reported high levels of parenting self-efficacy and satisfaction that was inversely related to dysfunctional disciplinary use. With more children surviving brain injury there is a growing need for rehabilitation services and in particular a greater need for well researched evidence-based intervention approaches. The findings suggest that behavioural interventions that utilise a family-centred approach are both clinically useful and efficacious in ameliorating negative sequelae for family, parent, and brain injured child.